GPs encouraged to use interpreters with CALD patients

Australia has long seen itself as an example of successful multiculturalism, with almost half of the population born overseas.
 
But when it comes to accessing appropriate healthcare, culturally and linguistically diverse (CALD) communities continue to face very real barriers, from low English proficiency and poor health literacy, to issues of housing and transport.
 
GPs have been vocal about the overarching consequences these barriers pose during a pandemic, fearing that messaging on general health and keeping COVID-safe is not far reaching enough people.
 
‘There were already barriers for CALD communities to access GP care, but with the COVID-19 pandemic these have significantly increased,’ Dr Kate Walker, Chair of the RACGP Specific Interests Refugee Health network, told newsGP.
 
‘The change to predominantly telehealth and decreasing access to other face-to-face healthcare and support services have added further barriers for patients with low English proficiency and low health and technology literacy.
 
‘There have [also] been lags with translating and disseminating COVID-19 information into accessible formats for CALD communities.’
 
National Health Survey data shows that 74% of those who migrated to Australia between 2009 and 2015 had visited a GP in the last 12 months, compared to 86% of the Australian-born population.  
 
GPs worry the disparity may be worsening, with some CALD people avoiding healthcare for fear of becoming infected with COVID-19 or being prosecuted due to police enforcement and the interplay with past trauma, particularly for refugees.
 
‘We have concerns this lack of access to care will lead to undertreated or deteriorating chronic conditions, delaying preventive care and worsening mental health,’ Dr Walker said. 
 


As has been seen in the US and UK, certain demographic variables such as a higher prevalence of chronic disease, working in high-risk professions, income inequality and overcrowded living conditions, can put ethnic minorities at greater risk of COVID-19.
 
‘Members of the CALD community live in areas where there is a high prevalence of COVID-19 and are at risk through overcrowded housing and working in frontline service jobs such as in the aged care sector, food distribution or in the meat works,’ Dr Walker said.
 
‘Unfortunately they may not be have adequate training or preventive measures in place in their workplaces.
 
‘GPs can also assess this risk and explain to patients how to address this.’
 
Translating information
English is not the first language for at least 15% of Australia’s population.
 
To help address the language barrier, the RACGP has expanded its campaign messaging through the Expert Advice Matters website, translated into Arabic, simplified and traditional Chinese, Hindi and Vietnamese.
 
GPs have joined the efforts by sharing videos of themselves speaking in various languages, urging patients not to delay routine healthcare and explaining how they can safely consult with their GP.
 
Dr Walker said GPs should not underestimate the importance of the relationships they have established with their CALD patients in helping to bridge the healthcare gap, and encourages regular follow-up of vulnerable patients.  
 
‘Pre-existing relationships and trust assists greatly with delivering accurate health messages through telehealth,’ she said.
 
‘Knowledge of that patient’s family, housing, and occupational and social background, really helps with trying to address their immediate healthcare needs, but also those broader issues – preventing COVID, talking through when to present if they have symptoms, where to get tested and how they might prevent the spread in their household.’
 
Dr Walker says for GPs who do not speak the same first language as their patients, working with an interpreter during a consultation, including telehealth, is important.
 
GPs can register through the Australian Government’s Translating and Interpreting Service (TIS) to gain free access to a dedicated medical practitioner priority line.
 
‘It is really easy to organise an interpreter,’ Dr Walker said. ‘Once you have your TIS code, you can directly access those interpreters.’
 
For GPs working in practices offering COVID testing and in respiratory clinics, taking extra time with CALD community members may be necessary to explain the self-isolation measures required until test results are available.
 
‘Simply handing someone a piece of paper will not get the message through, particularly for people with low health literacy or language barriers,’ Dr Walker said.
 
‘So a verbal explanation, with an interpreter if needed, of exactly what self-isolation means is critically important for preventing the spread.
 
‘Using a technique called teach-back is useful, where the patient explains to you what they have understood of the plan, again with the interpreter if needed.’
 
For CALD patients who test positive to COVID-19, Dr Walker recommends again working with an interpreter to ensure the patient understands the implications of a positive result, what symptoms to look out for if they start to deteriorate, and what the next steps will be regarding treatment and management.
 
‘GPs’ pre-existing relationships will also really help in caring for people who are COVID-positive and supporting their families during quarantine,’ she said.
 
‘GPs in Victoria can play an active role in assisting contact tracing to be done, and to help explain the detail around self-isolation and quarantine measures, which are critical to preventing further spread.’
 
While the role of GPs and multilingual campaigns like Expert Advice Matters are important, Dr Walker says it is ‘fundamental’ that governments work directly with CALD communities to get health messaging out.
 
Dr Walker also believes, however, that fundamental data needed to properly tailor the health response is missing, suggesting that ‘country of origin’ and ‘language spoken at home’ are both questions that should be asked of people at the time of testing. 
 
‘If we know which groups are accessing testing and what languages they require, then we can plan the health response better,’ she said.
 
‘We will know who’s getting tested, who’s not getting tested, what resources we need to develop just to tailor the response for these groups and make sure the messages are getting through.’
 
Resources

• GPs can register for a free TIS code by calling 1300 131 450 or visiting the TIS website
• The RACGP’s Telehealth consultations with patients requiring an interpreter
• Guide for clinicians working with interpreters in healthcare settings
• Australian refugee health practice guide
• Australian guidelines for the prevention and treatment of acute stress disorder, post-traumatic stress disorder and complex PTSD, chapter on the psychological care of traumatised refugees and asylum seekers
• Generally Speaking podcast episode on refugee and asylum seeker health

CALD coronavirus COVID-19 health literacy